Vol 14 (2017) - Issue 3

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Challenges Faced when Restructuring in the NHS

The UK’s National Health Service is the world’s fifth largest employer, with 1.2 million employees. It is free at the point of use for UK residents and paid for out of general taxation rather than any insurance-based system.
A growing and ageing population, patients’ rising expectations and an increased prevalence of long-term conditions have increased demand for the NHS, while rising staff costs, diminishing cost savings and cuts to social care and public health budgets are a strain on the health service.
Last year the British Medical Association (BMA) called a strike among junior doctors and members voted in favour, staging a series of walk-outs for the first time since the 1970s.1 In December the Red Cross was called in to help get people home from hospital to free up beds. Finances are in disarray, with 75% of acute hospitals and 65% of all NHS Trusts in deficit.2 The NHS annual budget of £120bn for 2016-17 is set to grow to £133bn in 2020-21, a real increase of 4.5%, according to the Kings Fund, a respected healthcare charity.3 It is generally recognised that this is not enough to cover the increasing burdens placed on the health service in its current form, and there is a growing acceptance of the need for extensive restructuring to make the NHS sustainable in the longer term.


The challenge
There is increasing recognition amongst all stakeholders – clinicians, administrative staff, patients and user groups – that major ‘surgery’ is needed. Turnaround practitioners have a key role to play in meeting the challenge but, if they are to be successful, they will have to adapt techniques and processes that work in other public and private sector organisations. The NHS is implementing a range of turnaround programmes and it is only when all stakeholders are working in
harmony that projects deliver their goal of sustainable service delivery.
Experience, expertise and a deep operational understanding of the NHS need to be applied to every project, and we draw on an extensive network of clinicians and former operational leaders from the health sector. Restructurings can be either informal reorganisations or formal situations.
Of critical importance is that the health service continues functioning on a daily basis and patient care is not compromised. Lack of funding options, the interconnected nature of the NHS, the need to engage with multiple stakeholders, organisational fatigue and a lack of capacity within hospitals, are all challenges that need to be addressed.